Entries in Riddle, Clive (307)

Friday
Aug172018

Healthcare costs – not grandchildren gone wild – the top retiree concern

By Clive Riddle, August 17, 2018

 

What’s the top concern about retirement years voiced by retirees as well as retirement plan sponsors? Its not grandchildren gone wild, keeping up with new technology, staying ahead of future inflation, or even staying in good health. Instead, its paying for that health.

 

Results just released from the 2018 TIAA Plan Sponsor Survey of 1,001 plans sponsors from nonprofit and for-profit organizations found that 91% of plan sponsors believe that healthcare costs are the most significant retirement security issue today. 54% answered very significant and 26% said somewhat significant, while 2% were neutral and – the plan sponsors I’m curious about: 3% said not at all significant.) After health care at 91%, the next highest concern of the top six: Ensuring employees are prepared to retire on a timely basis total 81% saying it was very or somewhat significant.

 

Meanwhile, another new survey tells us even affluent retirees are plenty scared about those retirement costs. A new Nationwide Retirement Institute survey of adults age 50+ with household income exceeding $150k, conducted by the Harris Poll indicates that 73% of affluent, older adults “list out-of-control health care costs as one of their top fears in retirement and 64 percent of future retirees say they are ‘terrified’ of what health care costs may do to their retirement plans.”

 

Here’s more of Nationwide’s survey findings:

  •  72% wish they better understood Medicare coverage
  •  42% admit they would give away all their money to their children so they could be eligible for Medicaid-funded long-term care.
  •  53% do not know that Medicare Part B is not free even if you have worked and paid Social Security taxes for at least 10 years
  •  23% do not know you cannot enroll in Medicare at any time
  •  29% do not know Medicare does not cost the same for everyone
  •  62% do not know that future changes will impact the ability to sign up for Medigap/Medicare supplement   plans
  •  53% are unsure or can't estimate what their annual health care will be
  •  65% are unsure what their long-term care costs will be
  •  27% of even these affluent, older adults say they couldn't cover more than $1,000 in unplanned expenses:   44% couldn't cover more than $4,000 and 60%couldn't cover more than $5,000 of unplanned expenses
  •  50 % have access to a Health Savings Account (HSA) through their employer, with 30% participating in or   contributing to the HSA

 

 

Friday
Aug102018

25 Things to Know About The CMS Medicare ACO Proposed Rule: Pathways to Success

By Clive Riddle, August 10, 2018

Here are 25 major points to note in the CMS Pathways to Success Proposed Rule introduced on August 9th:

  1. The redesigned Medicare Shared Savings program is called “Pathways to Success.
  2. There are five stated goals Pathways to Success is intended to advance: Accountability, Competition, Engagement, Integrity, and Quality.
  3. The CMS projected financial impact of the proposal would be savings to Medicare of $2.2 billion over ten years.
  4. CMS notes that 460 of the 561 or 82% of all ACOs in the Shared Savings Program in 2018 – are not taking on risk for increases in costs.
  5. The amount of time that an ACO can remain in the program with upside-only risk  would be limited to two years (or one year for ACOs identified as having previously participated in MSSP under upside-only risk) instead of the current timetable of up to six years.
  6. A 6-month extension would be provided for current ACOs whose agreements expire at the end of 2018, along with a special one-time July 1, 2019 start date that will have a spring 2019 application period for the new participation options.
  7. The number of tracks would be reduced to two, the “BASIC” track and the “ENHANCED” track, and would allow providers to pick between these two tracks. 
  8. The length of ACO participation agreements would expand from three years to five years.
  9. The BASIC track would feature a glide path for taking risk.  It would begin with up to two years of upside-only risk and then gradually transition in years three, four, and five to increasing levels of performance risk, concluding in year five at a level of risk that meets the standard to qualify as an Advanced Alternative Payment Model (APM) under MACRA. 
  10. Current upside-only ACOs would be limited to one year without risk before being required to transition to the risk level in year three of the glide path.
  11. The ENHANCED track would allow providers to take on risk and qualify as an Advanced APM immediately.  This track would offer the same amount of risk for each of the five years of the agreement period, at a level of risk sharing higher than the maximum amount reached in the BASIC track.
  12. Eligible ACOs (ACOs that are inexperienced with two-sided risk in Medicare) would be able to enter at any level of risk in the BASIC track’s glide path or go straight to the ENHANCED track.
  13. After completing a five-year agreement under the BASIC track, low revenue ACOs would be able to renew for a second agreement period at the highest level of risk in the BASIC track, while high revenue ACOs would be required to move to the ENHANCED track and take on additional risk.
  14. Each ACO would provide a standardized written notice to its Medicare beneficiaries, informing them at their first primary care visit of a performance year that they are in an ACO and what that means for their care.
  15. CMS would allow certain two-sided ACOs to provide an incentive payment of up to $20 to each assigned beneficiary for each qualifying primary care service that the beneficiary receives, as an incentive for taking steps to achieve and maintain good health. 
  16. CMS is seeking comment on an approach that would allow beneficiaries to opt in to an ACO as an alternative to assignment. 
  17. CMS would streamline the measures that ACOs are required to report, to ensure that all measures have a meaningful impact on patient care.
  18. CMS would require a specified percentage of the eligible clinicians participating in an ACO to adopt the 2015 edition of Certified EHR Technology (CEHRT) as part of the Administration’s MyHealthEData initiative promoting interoperability of medical data and patient control of their data.
  19. Physicians in ACOs that take on risk could receive payment for telehealth services provided to patients regardless of the patient’s location.
  20. Regional (county-level) spending would be incorporated into ACO benchmarks starting in their first agreement period.
  21. Methodology for risk adjustment would more accurately account for changes in beneficiaries’ health status.
  22. When calculating and updating benchmarks, CMS would factor in national spending growth rates in addition to regional rates, so ACOs that constitute a large fraction of their local market would not be penalized if they reduce the market growth rate.
  23. ACOs in two-sided models would be accountable for losses even if they exit mid-way through a performance year.
  24. Termination of ACOs with multiple years of poor financial performance would be authorized.
  25. The detailed Medicare Shared Savings Program Notice of Proposed Rulemaking (CMS-1701-P), “Accountable Care Organizations‑‑Pathways to Success,” is available at https://www.federalregister.gov/public-inspection/  and https://www.cms.gov/newsroom/fact-sheets/proposed-pathways-success-medicare-shared-savings-program.

 

Friday
Aug032018

Medicare Part D Premiums and Enrollment by the Numbers

By Clive Riddle, August 9, 2018

CMS this week announced that Part D premiums are expected to fall from $33.59 this year to $32.50 in 2019. Of course it’s not that simple. First of all, $32.50 is the “basic” premium rate. What Medicare beneficiaries actually pay is income adjusted on a sliding scale. Here are the 2019 “income-related monthly adjustment amounts” just released by CMS:

 

CMS informs us that:

  • “the base beneficiary premium is equal to the product of the beneficiary premium percentage and the national average monthly bid amount”
  • "the national average monthly bid amount is a weighted average of the standardized bid amounts for each stand-alone prescription drug plan and MA-PD plan.. The weights are based on the number of enrollees in each plan."
  • “The national average monthly bid amount for 2019 is $51.28.”
  • “The beneficiary premium percentage (“applicable percentage”) is a fraction, with a numerator of 25.5 percent and a denominator equal to 100 percent minus a percentage equal to (i) the total reinsurance payments that CMS estimates will be paid for the coverage year, divided by (ii) that amount plus the total payments that CMS estimates will be paid to Part D plans based on the standardized bid amount during the year, taking into account amounts paid by both CMS and plan enrollees.”
  • Using the above calculations “the Part D base beneficiary premium for 2019 is $33.19”
  • Then the Income-Related Monthly Adjustment Amounts “are determined by multiplying the standard base beneficiary premium by the following ratios: (35% − 25.5%)/25.5%, (50% − 25.5%)/25.5%, (65% − 25.5%)/25.5%, (80% − 25.5%)/25.5%, or (85 – 25.5%)/25.5%.

Clear as mud?

On the enrollment side of PDP world, here’s a look compiled from July 2018 CMS data:

Here are Medicare national drug plan enrollment totals:

  • Total PDP Contracts: 63
  • PDP Drug Plan Enrollment: 25,459,900
  • MA Drug Plan Enrollment: 18,004,980
  • PACE/Cost/Dual Drug Plan Enrollment: 689,113
  • Total Drug Plan Enrollment: 44,153,993

The top five states for PDP enrollment penetration are:

  • North Dakota – 63.9%
  • Vermont – 62.6%
  • Delaware – 62.6%
  • Iowa – 60.5%
  • Wyoming – 58.9%

This compares to a national average of 41.2% penetration. As one might expect, the high PDP penetration states have correspondingly lower Medicare Advantage penetration. For example, North Dakota has 2.7% MA penetration. Conversely, Puerto Rico has only 2.1% PDP penetration, but has the highest MA penetration at 71.1%. (national average MA penetration is 33.8%)

There are 114 counties with PDP penetration rates above 70.0%, mostly concentrated in the above states. Leading the pack is Dubuque County, Iowa at 72.3%. The bottom 77 of the 3,218 counties listed are all in Puerto Rico, as mentioned above. The first mainland county just above them is Clackamas County, Oregon with 17.6% penetration.

Friday
Jul202018

Consumers and Digital Technology: What’s the Deal With Healthcare?

by Clive Riddle, July 20, 2018 

The Deloitte Center for Health Solutions has just released some preliminary findings from their 2018 Survey of U.S. Health Care Consumers, which will be published in August, on the heels of their recently released Deloitte 2018 Survey of U.S. Physicians. Deloitte shares that “consumers and physicians typically agree that virtual health care holds great promise for transforming care delivery. Yet many physicians remain reluctant to embrace the technologies, worried about reimbursement, privacy and other issues.”

Thus Deloitte found consumers are well ahead of providers on the technology acceptance curve, and many providers are dragging their feet in meeting rising consumer demand in this arena. Dr. Ken Abrams, managing director, Deloitte Consulting tells us "Changes in health care reimbursement models, combined with growing consumer demand, are driving health systems to embrace virtual care, but they are struggling to get physicians on board."

The Deloitte surveys found:

  • 64% of consumers and 66% physicians “cite improved patient access as the top benefit of virtual care.”
  • “About half of physicians surveyed agree that virtual care supports the goals of patient-centricity, including improved patient satisfaction (52% agree) and staying connected with patients and their caregivers (45%  agree)
  • “While 57% of consumers favor video-based visits, only 14% of physicians surveyed have the capability today, and just 18% of the remainder plan to add this capability.”
  • “Clinicians worry about medical errors (36%) and data security and privacy (33%) associated with virtual care.”
  • “Email/patient portal consultations are the most prevalent virtual care technology used by responding physicians (38%), followed by physician-to-physician consultations (17%) and virtual/video visits (14%).”

Moving beyond just virtual care, and examining the healthcare digital experience as a whole, the global brand and marketing consultancy Prophet has just released a two part report: Making the Shift, Part I Healthcare’s Transformation to Consumer-Centricity (25 pages) and Part II  A Culture Change Playbook for Healthcare Transformation (also 25 pages.) They found that “ healthcare providers, payers and pharma companies are not making significant strides toward consumer centricity despite increasing demands and competition for healthcare dollars.”

Jeff Gourdji, a partner at Prophet, tells us  “consumers want to be treated as powerful participants in their own health.  Increasingly healthcare organizations’ own bottom lines require meeting consumers halfway or more. So, it is increasingly in everyone’s best interests to make sure consumers are empowered, engaged, equipped and enabled so they become what we call the ‘e-consumer.’”

Prophet paints the picture at the start of their report like this: “With the rise of digital technology, consumers have unprecedented power. Consumers expect business categories like retail and consumer goods to provide individual experiences across both the physical and digital worlds. While other businesses are shifting their focus toward delivering meaningful and valuable consumer experiences, healthcare has largely stayed the same. And, until recently, it hasn’t had the imperative to change. However, pressures from governments and employers to lower costs and pressures from consumers to meet ever rising expectations means that driving consumer engagement and redefining how healthcare organizations interact with people is no longer a luxury, but a necessity. While healthcare organizations are feeling pressure to upgrade their consumer experience, with a focus on how to engage and empower consumers, the path to accomplishing this is unclear.”

Immediately below this intro, the next section header asks “What’s the Deal with Healthcare?” They share survey results that “81 percent of consumers are dissatisfied with their healthcare experiences, and the happiest are those who interact with the system the least.”

Some of Prophet's other survey findings include:       

  • “Fewer than 10% of all healthcare organizations say they are “most willing” to partner with digital companies     
  • Only 21% of respondents believe that ‘practical and important innovation is coming from digital startups’ compared to over 50% of respondents who believe this innovation is coming from providers and medical device companies         
  • "Only about a quarter (27%) of surveyed companies measure relationship metrics like Net Promoter Score despite evidence that consumer metrics are critical to driving a commitment to consumer centricity.”
  • "Only 15% of respondents reported a willingness to consider adding leadership from outside the industry, even when those leaders would be supported by a healthcare-savvy team.

Prophet goes on to share on elaborate on “five shifts that organizations must prioritize to reshape into more consumer-centric businesses:

  1. Moving from tactical fixes to a holistic experience strategy
  2. Moving from fragmented care to connected ecosystems
  3. Moving from population-centric to person-centered
  4. Moving from incremental improvements to extensive innovation
  5. Moving from insights as a department to a culture of consumer obsession
Friday
Jul132018

The Physician’s Role in Today’s Healthcare Costs

By Clive Riddle, July 13, 2018

Influencing consumer behavior to reduce healthcare costs via cost sharing and engagement strategies, and purchaser cost containment strategies of all stripes have seemingly dominated discussions of regarding the cost of healthcare. So how to physicians feel about their role in the cost equation today?

A new seven page NEJM Catalyst Buzz Survey report sponsored by University of Utah Health has just been released: Cost of Care and Physician Responsibility.   The report presents findings from the University’s survey examining how clinicians view health care costs. They “found that while clinicians feel a great sense of responsibility around keeping costs affordable for patients, they don’t feel they have the tools to know, the time to discuss, or the ability to impact how much things costs,” and furthermore “the survey results show a disconnect: Physicians feel responsible for the cost of care to a patient, but not accountable for it,”

99% of surveyed physicians said that out of pocket costs are important to patients – 62% said extremely important, 32% said very important and 5% said important.  Physicians were asked “Do the following aspects of cost enter into clinical decisions at your organization?” 76% said yes to Cost to practice/system; 72% said yes to Out-of-pocket cost for patients; 68% said yes to Total cost of care; and 36% said yes to Contribution to overall national health costs.

How much impact does each of the following stakeholders have on the cost of health care? The percentage of physicians saying each stakeholders had a strong impact were:

  •           Pharmaceutical/biotech companies  - 87%
  •           Health plans/HMOs/insurers – 81%
  •           Hospitals/health systems/physician organizations – 75%
  •           Government/regulators – 67%
  •           Individual clinicians – 60%
  •           Employers – 28%
  •           Patients – 26%
  •           Medical device manufacturers – 23%

The percentage of physicians agreeing with the following statements were as follows:

  •           Health care costs are too confusing with current payer mix – 90%
  •           Physicians aren’t trained to discuss the cost of care – 86%
  •           The tools necessary to estimate costs to the patient are not available – 78%
  •           Tools necessary to estimate costs to health care delivery system, not available –77%
  •           There isn’t enough time in clinic to discuss cost of treatments with patients – 64%
  •           Physicians should make the best treatment decisions irrespective of cost – 57%
  •           Physicians should be held accountable for the cost of care to a patient – 28%
  •           It’s not the physician’s responsibility to educate patients about costs – 18%

Current strategies involving physicians are focused at the organizational level, such as with value based care and accountable care arrangements. When you get at the individual level, these survey results indicate that it would seem there is a reason current cost strategies emphasize purchaser and consumer solutions.